mosby ’spathology lesson 1.1 objectives massage · pdf filemosby ’spathology for...

Chapter 1Chapter 1

Disease Awareness Disease Awareness

and Infection Controland Infection Control

MosbyMosby’’ss PATHOLOGYPATHOLOGY

forfor Massage TherapistsMassage Therapists

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.2

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Lesson 1.1 ObjectivesLesson 1.1 Objectives

�� List and define terms related to the language of List and define terms related to the language of pathology.pathology.

�� Identify risk factors of diseases.Identify risk factors of diseases.

�� Discuss types and various agents of diseases.Discuss types and various agents of diseases.

�� Discuss physical effects of aging.Discuss physical effects of aging.

�� Contrast and compare relationships among Contrast and compare relationships among pathogens, reservoirs, and resultant infection or pathogens, reservoirs, and resultant infection or disease.disease.

3Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Introduction to PathologyIntroduction to Pathology

�� Steps to understanding pathology:Steps to understanding pathology:�� Acquire basic terminologyAcquire basic terminology

�� Review of normal anatomy and physiologyReview of normal anatomy and physiology

�� Goal of learning pathology in massage schools is Goal of learning pathology in massage schools is public safetypublic safety�� Continually check for most upContinually check for most up--toto--date medical date medical informationinformation


Language of PathologyLanguage of Pathology

�� Disease Disease –– condition of abnormal function condition of abnormal function involving anatomic structures or body systemsinvolving anatomic structures or body systems

――Characterized by recognizable set of signs Characterized by recognizable set of signs and symptomsand symptoms

�� Pathology Pathology –– study of diseasestudy of disease�� Includes causes and effects of diseaseIncludes causes and effects of disease

�� Diagnosis determines presence of diseaseDiagnosis determines presence of disease


Language of Pathology Language of Pathology (cont(cont’’d.)d.)

�� Diagnosis Diagnosis –– evaluation of physical signs and evaluation of physical signs and symptoms, medical history, physical symptoms, medical history, physical examination, and other procedures that lead to examination, and other procedures that lead to identifying particular diseasesidentifying particular diseases

�� Prognosis Prognosis –– prediction of how disease will prediction of how disease will progress and chances of recoveryprogress and chances of recovery



�� Signs Signs –– objective indicators of disease obvious objective indicators of disease obvious to someone other than affected individualto someone other than affected individual�� Can be measured and observedCan be measured and observed

�� Symptoms Symptoms –– subjective feelings of which only subjective feelings of which only the affected person is awarethe affected person is aware

�� Asymptomatic Asymptomatic –– disease without symptomsdisease without symptoms



�� Syndrome Syndrome –– group of signs and symptoms group of signs and symptoms

occurring together to present a disease or occurring together to present a disease or

abnormality abnormality

�� Etiology Etiology –– causes or origins of diseasecauses or origins of disease

�� Idiopathic Idiopathic –– disease without a known causedisease without a known cause

�� Risk factors Risk factors –– tendencies that promote disease tendencies that promote disease

developmentdevelopment



�� Disease can be described by its degree of Disease can be described by its degree of

involvement:involvement:

�� Local disease: affects one body areaLocal disease: affects one body area

�� Systemic disease: distributed throughout the bodySystemic disease: distributed throughout the body

�� Acute disease: abrupt onset and runs a brief courseAcute disease: abrupt onset and runs a brief course

�� Chronic disease: develops gradually, vague or mild Chronic disease: develops gradually, vague or mild

symptoms, lasts longer than 6 mo. symptoms, lasts longer than 6 mo.



�� Remission Remission –– period of partial or complete period of partial or complete disappearance of signs and symptomsdisappearance of signs and symptoms

�� Exacerbation Exacerbation –– period of increased signs and period of increased signs and symptomssymptoms

�� Complications Complications –– conditions arising after onset conditions arising after onset of original diseaseof original disease



�� Epidemic Epidemic –– occurs when a disease affects a occurs when a disease affects a large number of people at the same time large number of people at the same time within a regionwithin a region

�� Pandemic Pandemic –– disease that involves large disease that involves large numbers of people in several regions, even numbers of people in several regions, even worldwideworldwide

�� Morbidity Morbidity –– rate a disease occurs within a rate a disease occurs within a group or areagroup or area

�� Mortality Mortality –– number of deaths resulting from a number of deaths resulting from a disease in a given time perioddisease in a given time period


Leading Causes of Death in the Leading Causes of Death in the

United States (2004)United States (2004)

1.1. Heart diseaseHeart disease

2.2. CancerCancer

3.3. StrokeStroke

4.4. Chronic lower Chronic lower

respiratory diseaserespiratory disease

5.5. AccidentsAccidents

6.6. DiabetesDiabetes

7.7. Pneumonia/ Pneumonia/

influenzainfluenza

8.8. Kidney diseaseKidney disease

9.9. SepticemiaSepticemia

10.10. Liver disease Liver disease



�� Incidence Incidence –– number of new number of new

cases in a particular cases in a particular

population during a period population during a period

of timeof time

�� Prevalence Prevalence –– number of number of

existing new and old cases existing new and old cases

of a disease within a of a disease within a

specific population and specific population and

time periodtime period

From Gould BE: From Gould BE: PathophysiologyPathophysiology for the health for the health

professions, professions, eded 3, 2006, St. Louis, Saunders.3, 2006, St. Louis, Saunders.


Risk Factors for DiseaseRisk Factors for Disease

�� Risk factors make a group or individual more Risk factors make a group or individual more likely to contract a disease likely to contract a disease

�� Examples of risk factors are:Examples of risk factors are:�� AgeAge

�� GenderGender

�� GeneticsGenetics

�� LifestyleLifestyle

�� EnvironmentEnvironment

�� StressStress


Types of Diseases: AutoimmuneTypes of Diseases: Autoimmune

�� Inappropriate or excessive immune system Inappropriate or excessive immune system responseresponse

–– Immune system doesnImmune system doesn’’t t distinguish between distinguish between body tissue and foreign body tissue and foreign materialmaterial

–– Immune system attacks Immune system attacks body tissuebody tissue

–– Depletes immune Depletes immune system and its ability to system and its ability to respond to real threatsrespond to real threats

From Jarvis C: From Jarvis C: Physical examination and health assessment, Physical examination and health assessment,

ed. 4, Philadelphia, 2004, Saunders.ed. 4, Philadelphia, 2004, Saunders.


Types of Diseases: CancerousTypes of Diseases: Cancerous

�� Uncontrollable growth of abnormal cellsUncontrollable growth of abnormal cells

�� Cancerous (malignant) tumors will often metastasize Cancerous (malignant) tumors will often metastasize

(or spread) to other body parts(or spread) to other body parts

–– Noncancerous (benign) Noncancerous (benign) tumors dontumors don’’t metastasize, t metastasize, but may become life but may become life threatening if they put threatening if they put pressure on vital areaspressure on vital areas

From From deVivierdeVivier A: A: Atlas of Clinical Dermatology, Atlas of Clinical Dermatology, eded 2, 2,

London, 1993, Gower Medical Publishing.London, 1993, Gower Medical Publishing.


Types of Diseases: DeficiencyTypes of Diseases: Deficiency

�� Deficiencies result from:Deficiencies result from:�� Lack of an essential vitamin, nutrient, or mineral in Lack of an essential vitamin, nutrient, or mineral in the dietthe diet

�� Inability to digest or absorb nutrientsInability to digest or absorb nutrients

�� Interferes with growth, development, and Interferes with growth, development, and metabolismmetabolism

Courtesy Dr. RH MacDonald. In Courtesy Dr. RH MacDonald. In KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color Color

atlas of geriatric medicine, atlas of geriatric medicine, ed. 2, St. Louis, 1991, Mosby.ed. 2, St. Louis, 1991, Mosby.


Types of Diseases: DegenerativeTypes of Diseases: Degenerative

�� Caused by tissue breakdown from:Caused by tissue breakdown from:�� OveruseOveruse

�� The aging processThe aging process

From From CotranCotran RS, Kumar V, Collins T: RS, Kumar V, Collins T: RobbinRobbin’’ss pathologic basis of disease, pathologic basis of disease, eded 7, Philadelphia, 2005, Saunders.7, Philadelphia, 2005, Saunders.


Types of Diseases: GeneticTypes of Diseases: Genetic

�� Caused by abnormality in genetic codeCaused by abnormality in genetic code

�� Can be:Can be:�� InheritedInherited

�� Result from spontaneous mutationResult from spontaneous mutation

A, From A, From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions, related professions, eded 2, Philadelphia, 2000, Saunders; 2, Philadelphia, 2000, Saunders;

B, Courtesy A. Olney and B, Courtesy A. Olney and M.MacDonaldM.MacDonald, University of Nebraska Medical Center, Omaha, Nebraska., University of Nebraska Medical Center, Omaha, Nebraska.


Types of Diseases: InfectiousTypes of Diseases: Infectious

�� Caused by biologic agents such as bacteria Caused by biologic agents such as bacteria and fungiand fungi

�� Transmitted by a reservoir (sources of infection) Transmitted by a reservoir (sources of infection) onto a host whereonto a host where pathogens residepathogens reside

�� Hosts Hosts –– organisms in which pathogens resideorganisms in which pathogens reside

�� Infectious diseases are contagiousInfectious diseases are contagious

�� Also called communicable diseasesAlso called communicable diseases


Types of Diseases: MetabolicTypes of Diseases: Metabolic

�� Physiologic dysfunctions Physiologic dysfunctions

that disrupt metabolismthat disrupt metabolism

From From DamjanovDamjanov I: I: Pathology for the health Pathology for the health

professionsprofessions, , eded 3, St. Louis, 2006, Saunders.3, St. Louis, 2006, Saunders.


Types of Diseases: Congenital Types of Diseases: Congenital

DisordersDisorders

�� Present at birthPresent at birth

�� Result from:Result from:�� Genetic abnormalitiesGenetic abnormalities

�� Maternal dietMaternal diet

�� Habits of pregnant Habits of pregnant mother (smoking, alcohol mother (smoking, alcohol use)use)

�� Fetal oxygen deprivationFetal oxygen deprivation

From From ZitelliZitelli B, Davis H: B, Davis H: Atlas of pediatric physical Atlas of pediatric physical

diagnosis, diagnosis, eded 5, 2007, Mosby.5, 2007, Mosby.


Types of Diseases: Traumatic Types of Diseases: Traumatic

DisordersDisorders

�� Result from injuriesResult from injuries

�� Examples are:Examples are:�� WoundsWounds

�� FracturesFractures

�� Spinal cord injuriesSpinal cord injuries

�� Head injuries Head injuries


Agents of DiseaseAgents of Disease

�� Pathogen Pathogen –– agent of diseaseagent of disease

�� Contamination Contamination –– occurs when pathogens reside occurs when pathogens reside on an organismon an organism

�� Four basic pathogenic agents:Four basic pathogenic agents:�� BacteriaBacteria

�� FungiFungi

�� ProtozoaProtozoa

�� VirusesViruses


Agents of Disease: BacteriaAgents of Disease: Bacteria

�� Unicellular microorganismsUnicellular microorganisms

�� Most are not pathogenicMost are not pathogenic

�� May be transmitted from May be transmitted from

another person, an animal, a another person, an animal, a

fomitefomite (inanimate object), (inanimate object),

ingestion of contaminated ingestion of contaminated

food, or from not washing food, or from not washing

hands after toilet usehands after toilet use

From Kumar V, From Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran pathologic basis of disease, pathologic basis of disease, eded 7, 2005, Philadelphia, Saunders.7, 2005, Philadelphia, Saunders.


Courtesy of Dr. Dominick Courtesy of Dr. Dominick CuvuotiCuvuoti, Department of Pathology, University of Texas , Department of Pathology, University of Texas

Southwestern Medical School, Dallas, TX, In Kumar V, Southwestern Medical School, Dallas, TX, In Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N:

Robbins & Robbins & CotranCotran Pathologic basis of disease, Pathologic basis of disease, eded 7, 2005, Philadelphia, Saunders7, 2005, Philadelphia, Saunders

Agents of Disease: FungiAgents of Disease: Fungi

�� Examples are molds and yeastsExamples are molds and yeasts

�� They thrive in warm, moist environmentsThey thrive in warm, moist environments

�� Usually transmitted by a Usually transmitted by a fomitefomite

�� Infections are usually superficial but can be Infections are usually superficial but can be

systemicsystemic


Agents of Disease: ProtozoaAgents of Disease: Protozoa

�� Simplest form of animal lifeSimplest form of animal life

�� Pathogenic protozoa can survive only in a Pathogenic protozoa can survive only in a living subjectliving subject

�� Transmitted through feces, contaminated Transmitted through feces, contaminated food or water, or insect bites and stingsfood or water, or insect bites and stings

Courtesy of Lynne Garcia, LSG and Associates, Santa Monica, CA, Courtesy of Lynne Garcia, LSG and Associates, Santa Monica, CA, In Kumar V, In Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran pathologic basis of pathologic basis of

disease, disease, eded 7, 2005, Philadelphia, Saunders.7, 2005, Philadelphia, Saunders.


Agents of Disease: Viruses Agents of Disease: Viruses

�� Nonliving entitiesNonliving entities

�� Viruses inject their Viruses inject their genetic material into host genetic material into host cells, then use host cells cells, then use host cells to replicateto replicate

�� Viruses cannot be killed Viruses cannot be killed by antibioticsby antibiotics

From Kumar V, From Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran Pathologic Pathologic

basis of disease, basis of disease, eded 7, 2005, Philadelphia, Saunders.7, 2005, Philadelphia, Saunders.


Agents of Disease: Other Agents of Disease: Other

�� Parasites Parasites –– rely on host for nourishmentrely on host for nourishment

�� Plant resins such as poison oak can cause Plant resins such as poison oak can cause diseasedisease

�� PrionsPrions cause a few diseases in mammals and cause a few diseases in mammals and humanshumans�� Affect the central nervous systemAffect the central nervous system

�� Untreatable and fatalUntreatable and fatal

�� Extremely rareExtremely rare


Lesson 1.2 Objectives Lesson 1.2 Objectives

�� Explain modes of disease transmission.Explain modes of disease transmission.

�� Discuss hostDiscuss host--pathogen relationships.pathogen relationships.

�� List ways therapists can reduce disease List ways therapists can reduce disease transmission.transmission.

�� List examples of universal precautions.List examples of universal precautions.

�� Discuss glove use in massage therapy.Discuss glove use in massage therapy.

�� Explain and demonstrate handExplain and demonstrate hand--washing washing procedure.procedure.


Modes of TransmissionModes of Transmission

�� Direct physical contactDirect physical contact�� Mucous membranesMucous membranes

�� Intact skinIntact skin

�� Broken skinBroken skin

�� Indirect physical contactIndirect physical contact�� InhalationInhalation

�� IngestionIngestion

From Christensen BL, From Christensen BL, KockrowKockrow ED: ED: Foundations of nursing, Foundations of nursing, eded 5, 2006, St. Louis, Mosby.5, 2006, St. Louis, Mosby.


HostHost--Pathogen RelationshipPathogen Relationship

�� A pathogenA pathogen’’s success depends on:s success depends on:�� Ability to gain accessAbility to gain access

�� Areas of body attackedAreas of body attacked

�� Ability to spread and replicateAbility to spread and replicate

�� Resistance to host defensesResistance to host defenses


HostHost--Pathogen RelationshipPathogen Relationship(cont(cont’’d.)d.)

�� Defense Defense mechanisms:mechanisms:�� Physical and chemical Physical and chemical barriersbarriers

�� Inflammation (helps Inflammation (helps contain infection)contain infection)

�� Immune responseImmune response

From Grimes DE: From Grimes DE: Infectious diseases, Infectious diseases, St. Louis, St. Louis,

1991, Mosby.1991, Mosby.



�� Immune system can be suppressed by chronic Immune system can be suppressed by chronic stress, malnutrition, some medications, and stress, malnutrition, some medications, and illnesses already presentillnesses already present

�� Various signs and symptoms show that the Various signs and symptoms show that the immune system is fighting infectionimmune system is fighting infection�� FeverFever

�� NauseaNausea

�� Elevated white blood cell countElevated white blood cell count

�� General feeling of low energyGeneral feeling of low energy



�� Disease process includes:Disease process includes:�� Course of infectionCourse of infection

�� Incubation (time between exposure and symptom Incubation (time between exposure and symptom onset)onset)

�� Exacerbation (period of symptoms)Exacerbation (period of symptoms)

�� Remission (partial or complete symptom Remission (partial or complete symptom disappearance)disappearance)


Infection Control in a Massage Infection Control in a Massage

Practice Practice

�� Infectious agents can be spread through Infectious agents can be spread through contact with:contact with:�� Contaminated linensContaminated linens

�� Contaminated massage toolsContaminated massage tools

�� Open containers of contaminated lubricant Open containers of contaminated lubricant



Practice Practice

�� Have a plan to prevent crossHave a plan to prevent cross--contamination contamination (passing of microorganism from one person to (passing of microorganism from one person to another)another)

�� Apply sanitation (measures to promote a Apply sanitation (measures to promote a healthful, diseasehealthful, disease--free environment)free environment)

�� Receive recommended or required Receive recommended or required vaccinationsvaccinations



Practice Practice

�� Universal PrecautionsUniversal Precautions�� Established by the Centers for Disease Control Established by the Centers for Disease Control and Prevention (CDC)and Prevention (CDC)

�� Requires health care providers to prescribe to a Requires health care providers to prescribe to a plan that helps prevent exposure to and spreading plan that helps prevent exposure to and spreading of bloodof blood--borne and fluidborne and fluid--borne pathogens borne pathogens

�� These reduce transmission of communicable These reduce transmission of communicable diseasesdiseases


Sanitary GuidelinesSanitary Guidelines

�� Use an approved handUse an approved hand--washing procedurewashing procedure

�� Avoid wearing jewelryAvoid wearing jewelry

�� Keep nails clean, short, and without polishKeep nails clean, short, and without polish

�� Keep hair clean and away from faceKeep hair clean and away from face

�� Use clean linens and launder after useUse clean linens and launder after use

�� Prescribe to a safe method of handling Prescribe to a safe method of handling contaminated linens and massage toolscontaminated linens and massage tools


Sanitary GuidelinesSanitary Guidelines (cont(cont’’d.)d.)

�� Treat any substance that cannot be identified Treat any substance that cannot be identified

as unsafeas unsafe

�� Wear a clean uniform each dayWear a clean uniform each day

�� Use a pump dispenser or clean singleUse a pump dispenser or clean single--use use dish for massage lubricantdish for massage lubricant

�� Use gloves when appropriateUse gloves when appropriate

�� Do not perform massage when ill Do not perform massage when ill


Sanitary GuidelinesSanitary Guidelines (cont(cont’’d.)d.)

�� Avoid working under the influence of alcohol or Avoid working under the influence of alcohol or recreational drugsrecreational drugs

�� Avoid massaging clients who are illAvoid massaging clients who are ill

�� Be prepared for emergency situationsBe prepared for emergency situations


Glove UseGlove Use

�� Use gloves when:Use gloves when:�� Handling any form of blood or other body fluid or Handling any form of blood or other body fluid or secretionssecretions

�� Any time the therapist has a break in the skin or Any time the therapist has a break in the skin or skin infection on the handsskin infection on the hands

�� When working in the oral cavityWhen working in the oral cavity

�� When the client requests itWhen the client requests it


Glove UseGlove Use (cont(cont’’d.)d.)

�� Latex glovesLatex gloves�� Are thin, strong, and conform to therapistAre thin, strong, and conform to therapist’’s handss hands

�� Requires waterRequires water--based lubricantsbased lubricants

�� Some people have latex allergiesSome people have latex allergies

�� Vinyl glovesVinyl gloves�� Are thicker and more expensive Are thicker and more expensive

�� Can be used with oilCan be used with oil--based lubricantsbased lubricants


Glove UseGlove Use (cont(cont’’d.)d.)

�� Removing Removing gloves:gloves:


Hand Washing Procedure Hand Washing Procedure


Hand Washing Procedure Hand Washing Procedure (cont(cont’’d.)d.)

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